Street drugs

August 2010


Type 2 diabetes

Controlling hyperglycaemia with early insulin use

Volume 39, No.8, August 2010 Pages 565-569

Richard J MacIsaac

Ada Cheung

George Jerums


Many patients with type 2 diabetes need to progress to insulin use when oral glucose lowering therapies fail to maintain adequate glycaemic control.


To suggest when and how to initiate insulin therapy for patients with type 2 diabetes in the primary care setting.


In general, initiation of insulin should be considered in individuals on maximal tolerated doses of metformin and sulfonylureas with HbA1c levels >7.0% over a 3–6 month period. Current Australian guidelines recommend initiating insulin therapy as once daily basal therapy or as premixed insulins.

Type 2 diabetes is characterised by insulin resistance, a progressive decline in beta-cell function, and worsening hyperglycaemia. HbA1c levels of <7.0% remain the target for good glucose control but individualisation of glycaemic targets has been advocated by the Australian Diabetes Society (Table 1).1

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